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Global Health Science: Beyond Infections
A Strategy for investment in Non-communicable Disease Research
MRC has a longstanding commitment to global health research. In partnership with Low
and Middle Income Countries (LMICs), and aligned with global initiatives, we have made
substantial contributions to the fight against infectious disease 1. Continuing this
tradition, MRC, working with other Research Council and funding partners, is making
major contributions to AMR research, vaccine development, emerging infections and
pandemic preparedness.
We recognise the need to sustain and strengthen these efforts over the next two
decades. However, the health needs of the LMICs are evolving. Improving
infrastructures and service delivery for the prevention and treatment of infectious
diseases and increasing relative prosperity driving urbanisation are changing healthrelated behaviours (eg. patterns of physical activity, diet, tobacco and alcohol
consumption). As a result, non-communicable diseases represent the new health
challenge (See figure below showing data from WHO 2005 – ‘Other conditions’ comprises
communicable diseases, maternal and perinatal conditions and nutritional disorders). These
conditions were responsible for 63% of all global
deaths in 2008, a figure projected to rise to 75%
by 2030; 80% of NCD deaths now occur in LMICs
and half of those who die are in their most
economically productive years2. Even in Africa,
where the burden of communicable, maternal,
perinatal and nutrition related disease is high,
NCDs are predicted to become the major cause
of death within the next 15 years. Importantly,
these challenges are set against a backcloth of
an increasing burden from mental health
disorders (75% of which affect LMIC
populations3) and the impact of increasing life
expectancy.
Over the last five years the UK research effort in
non-communicable disease and health systems in LMICs has developed rapidly, but is
still on a relatively small scale (for MRC it represents less than 25% of the global health
portfolio). To catalyse further change to meet the emerging challenge we now need to
increase the breadth and scale of UK research, and widen our international partnerships.
Improving health in LMICs will need a broad range of approaches relevant to noncommunicable disease, and to the wider social, economic, cultural and environmental
contexts that affect health, embracing new discovery science and translational
programmes in partnership with LMICs, NGOs and industry:
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The pattern of health and disease – in areas ranging from hypertension to
diabetes, stroke and mental health – often differs substantially from that seen in
the most developed countries, with differences in risk associations, age of onset,
progression, and symptoms. Often, in LMICs, disease epidemiology is not well
described. Effective prevention, early detection, and treatment, needs a full
In particular, malaria, TB and HIV
WHO Global Status Report on Noncommunicable Diseases, 2010
APPG Report on Mental Health for Sustainable Development, 2014
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understanding of the variations in patterns of disease and their biomedical and
environmental4 causes (including the social and cultural environment).
Even when direct factors influencing health – such as food intake – are well
known, the wider context that shapes these risk factors for individuals and
populations will vary widely between LMICs, and in many cases will be changing
more rapidly than in the most developed countries. New approaches are needed
in population, social, economic, cultural and environmental research – exploring
the interplay between health and variation in food and nutrition, occupational
risk, culture, education and lifestyle, and changing rural and urban environments.
Translating scientific understanding of NCDs into health, societal and economic
gains will call for new designs and technologies, and evaluative research, for
prevention, for clinical care and to understand the contribution of social and
cultural factors and context. UK research will need wider partnerships with public
and private organisations in LMICs to achieve impact, and for some LMICs
contributing to a strengthened national research capability will also be a
prerequisite.
A more complete global research approach to non-communicable disease will benefit
research in developed countries as well as LMICs. Understanding wider and more
extreme variation in diet, in environment, or in early life; and a more complete
understanding of human biological social and cultural variability, will undoubtedly give
new insights into universal processes in human health and disease.
Areas of interest
i. Research opportunities: We are open to supporting new research in any area of health.
There are no areas of global NCD research which are so well developed that they are a
lower priority for new funding. However, to illustrate the research opportunities, there
are some overlapping areas where there are obvious gaps in knowledge and where UK
research, in partnership, should be well placed to contribute:
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Cardiovascular and metabolic research
Cancers of high prevalence in LMICs
Mental health and neurocognitive development
Adolescent, maternal, and childhood health
Impacts of demographic/behavioural changes across the lifecourse (including food
and nutrition, malnutrition, obesity and physical activity) and cultural factors, with a
focus on maintaining health
Environmental change – urbanisation, rural change, climate change, environmental
degradation
Technologies, designs and methods suited to LMICs – including opportunities for
informatics, user-led service design in research and health policy support; biomedical
technologies; new forms of data; research tools and methods
Across all of these examples, the research challenges range across the spectrum of
research MRC and partners already supports, from fundamental work on resilience to
disease, disease mechanisms and genetic/environmental interactions, to population and
social sciences, arts and humanities, and translational research. Aligned with MRC’s
wider priorities, opportunities for experimental medicine approaches will be emphasised.
Many will, in addition, need broader interdisciplinary scope, to achieve fuller
understanding of the effects / options for change that are determined by wider economic
factors; culture, media and society; food supply; variations in public service and
systems; urbanisation and urban design etc.
4
Throughout the document environment should be taken to mean both the physical and social environment
and environmental exposures includes social exposures
Exploration of complex interacting processes (either across coordinated projects, or
within larger programmes) will be needed in many areas. For example, in understanding
how diet, microbiome, early development and environment, infection and adult
environmental factors interact to shape metabolism and health; or in understanding how
early development, biology, culture and environment interact in mental health.
ii. Capability needs: research success will, in many cases, depend on sustained
development of research capability in Low- or Middle- income partner countries around
the research issue of focus. In many new research areas, initial funding support will
often need to build capability at the same time as building towards new knowledge.
Important areas are likely to include:
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Developing / enhancing longitudinal or cross-sectional population studies and
sampling
Ability to study broader environmental exposures including Social and cultural
influences and systems
Large scale data analysis
Capacity to join up data, align methods etc across countries or regions to enable
comparative studies or larger scale
Research collaborations, cross-cultural and public engagement and translational
collaborations
Research skills and technical and management skills
Research instruments, standards and methods tailored to the culture,
environment, or operational practicalities such as task shifting.
The Funding Challenge
MRC’s support for global health – over £250m over the last five years – has mainly been
delivered through conventional funding for Programmes and Projects, Units, Centres,
Fellowships and Translational grants. We expect funding to exceed £400m over the next
five years, mostly through the same mechanisms – but to fully capitalise on this
opportunity to diversify the global health portfolio and form new cross-Council links there
will be a need to fund both short-term and medium-term foundation/development
grants. These will provide a basis for larger investments in future years, many of which
will be collaborative cross-Council initiatives, and opportunities to work with other major
funders outside of the GCRF such as DfID, Wellcome Trust and the Gates Foundation.